Mixed Skin and Soft Tissue Infection Caused by Rhodotorula glutinis and Enterococcus faecalis in a Diabetic Patient: A Case Report.

Rhodotorula is a widely distributed fungus that has evolved as an important pathogen, especially in immunocompromised individuals, causing fungemias, central nervous system infections, peritoneal dialysis-associated peritonitis and keratitis. Even though there are a few reports of skin and soft tissue infections caused by Rhodotorula, all these cases involve immunocompromised individuals. Enterococcus faecalis is a Gram-positive bacterium known to cause several infections such as bloodstream, urinary tract and skin and soft tissue infections. We report a mixed Rhodotorula glutinis and Enterococcus faecalis skin and soft tissue infection in a 63-year-old woman with well controlled type 2 diabetes mellitus and no other known history of immunosuppression, suffering from skin and soft tissue infection of the right lower extremity. The patient did not respond to treatment with broad spectrum antimicrobials, but had a successful outcome with fluconazole, after Rhodotorula glutinis was isolated from pus of the skin ulcer. The antifungal treatment led to eradication of the infection, while no recurrence was observed during a follow-up period of two years. Clinicians should be aware that R. glutinis can cause infection even in immunocompetent patients.